The headline can be rewritten as: Evidence does not currently support gender surgeries for minors, says the president of the leading plastic surgeons organization.

The president of the American Society of Plastic Surgeons (ASPS) reaffirms the organization's stance that there is insufficient evidence to support gender-affirming care (GAC) for minors, as stated in a recent interview.

Dr. Steven Williams, ASPS President, discussed with Planet Chronicle Digital the organization's stance on GAC, which involves the use of puberty blockers, cross-sex hormones, and surgery for minors who experience gender distress.

A recent report from a Canadian think tank states that minors in the U.S. are one of the few Western countries where they can receive gender surgery, while in Belgium, Finland, Germany, Luxembourg, Sweden, the U.K., and three Canadian provinces, minors are not allowed to undergo a double mastectomy before 18, and nearly all European countries do not perform sex reassignment surgery before 18.

"According to Williams, gender-affirming care in adolescents requires additional work and evidence to support it. The reason for this is that adolescents are a vulnerable population that may not have the decision-making capacity of adults. Therefore, it is crucial to ensure that there is strong evidence to support gender-affirming care in this population. Currently, Williams believes that there is not enough evidence to support this type of care."

The American Society of Plastic Surgeons (ASPS), comprising 92% of all board-certified plastic surgeons in the US and over 11,000 surgeons worldwide, promotes high standards in training, ethics, physician practice, and research through education, advocacy, practice support, and increased public awareness of the importance of plastic surgery, as stated on their website.

The American Psychiatric Society (APS) has stated that it has not endorsed any organization's practice recommendations for the treatment of adolescents with gender dysphoria. The group emphasized that there is considerable uncertainty regarding the long-term efficacy of chest and genital surgical interventions, and that the existing evidence base is viewed as low quality/low certainty.

"The American Society of Plastic Surgeons (ASPS) is currently reviewing and prioritizing initiatives to support evidence-based gender surgical care, with the goal of providing guidance to plastic surgeons. As part of the multidisciplinary care team, plastic surgeons have a responsibility to provide comprehensive patient education and maintain a robust and evidence-based informed consent process, so that patients and their families can set realistic expectations in the shared decision-making context."

Williams explained that the issue of gender-affirming care is complex because it involves doctors with different perspectives, procedures, policies, and access to research.

"The American Society of Plastic Surgeons concentrates on plastic surgery, patient safety, and advancements in the field, so I am unsure where endocrinologists should stand. We do not align with any organization and must independently evaluate what is best for our members, patients, and the progress of plastic surgery in a safe and ethical manner."

Plastic surgeons' aesthetic operations are not always supported by strong evidence, as Williams pointed out.

""Tummy tucks and liposuction have limited evidence to support their effectiveness as the best surgery," he stated."

Williams contended that the distinction between adults and minors lies in the requirement for stronger evidence to demonstrate the necessity or benefits of surgical procedures for the latter group.

"Williams stated that most individuals would not agree to exclude gender dysphoria from receiving psychiatric care, counseling, or clinical support. However, as more permanent changes are made, the level of evidence required to support these decisions increases."

He maintained that adults, even those who have undergone tummy tucks or liposuction, may experience regrets, but these procedures do not necessitate a high level of data.

Adults can sometimes make decisions that they may later regret, but they have the capacity and resources to make those decisions. However, adolescents may not have the same tools, so the evidence needs to be stronger.

What is the role of surgeons in determining the medical necessity of GAC surgery, given that it is typically a later step in the gender-transition process and follows the use of puberty blockers and hormones?

According to Williams, surgery is rarely the first option considered, whether for adolescents or anyone else, and any surgical procedure is only performed if it is deemed beneficial and with the patient's best interests in mind.

"Do we have to operate, or is it our decision to evaluate the clinical evidence, communicate with the patient, and possibly consult specialists?" Williams questioned. "That's true for everything. I've never done a surgery where I felt like I had to follow someone else's orders because I had no choice."